Part B Insider (Multispecialty) Coding Alert

Published on Thu Oct 04, 2007 PDF

Republicans want to leave you hanging for 2009 payments

Say goodbye to your carriers in seven states and the District of Columbia.

The Centers for Medicare & Medicaid Services (CMS) has named two new Medical Administrative Contractors (MACs), which process both Part A and Part B claims. By Sept. 2008, Highmark Medicare Services will be the MAC for Delaware, Maryland, New Jersey, Pennsylvania and DC. Palmetto GBA will tackle California, Hawaii, Nevada, American Samoa, Guam and the Northern Mariana Islands by next June.

Medicare will pay Highmark and Palmetto bonuses based on their ability to meet or exceed CMS- performance requirements, including customer service, payment accuracy, provider education and cost savings.

CMS wants to have 15 MACs covering the entire nation by 2011.

In other news:

- Legislators continue to wrangle while steep cuts to your payments get closer. Democrats want to bail you out from the cuts slated for both 2008 and 2009. But Senate Finance Committee ranking member Charles Grassley (R-IA) wants a smaller, one-year fix, according to press reports.

That would cost less than a two-year fix ($10 billion instead of $20 billion to $25 billion.) But it would also raise the chances you-ll be left high and dry in 2009. During next year's election season, lawmakers will have a much harder time passing any kind of tough Medicare legislation.

The problem: How to pay for a pay fix. Senate Republicans also are resisting using cuts to Medicare Advantage plans to pay for the elimination of the two year, 15 percent cut. Cuts to other providers, including home health agencies, could provide money instead, say observers.

- Make sure you know where the funds are going next time the HHS Office of Inspector General wants to take back some of your money. OIG investigator Scott Allen Gompert pled guilty to stealing more than $1 million in allegedly fraudulent health care funds. Gompert used the money to buy property, including a 2005 Toyota Avalon, and pay off his mortgage, according to Associated Press.

Gompert used his connections as a health fraud investigator to identify bank accounts holding proceeds from fraud. Then he created fake seizure warrants and forged the signatures of federal judges, to transfer the money into his own bank account. He faces up to 35 years in prison and $1.2 million in fines. He already gave back $550,000 and the Toyota.